Blood vessel occlusion with erythrocyte aggregates causes burn injury progression: microvasculature dilation as a possible therapy

Abstract

Other than radiation, caustic strong alkali insults, and massive over-reactive inflammation (pyoderma gangrenosum), injury progression after trauma is usually secondary to ischemia from decreased blood vessel perfusion. Impeded blood flow contributes to injury progression in a variety of disorders including venous stasis ulcers, arterial ulcers, diabetic ulcers, flap and graft necrosis, sickle cell disease, cryoglobulinemia and other vasculopathies, vasculitis, post-myocardial infarction, and post stroke. The cause of impeded blood flow in these disorders/diseases is well known.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EQY8qH

Humoral immune responses to infection: common mechanisms and unique strategies to combat pathogen immune evasion tactics

Ismail Sebina | Marion Pepper

http://ift.tt/2F0GCiT

Tuberculous Enteritis Presenting as Acute Appendicitis and Perirectal Abscess

Mycobacterium tuberculosis has a wide variety of presentations. A rare occurrence is gastrointestinal tuberculosis. It may occur anywhere along the alimentary canal but usually occurs in the ileocecum with rare involvement of the appendix.

http://ift.tt/2GK0ZOL

Poor inter-rater reliability of hidradenitis suppurativa phenotypes

http://ift.tt/2ooJNHU

Value of the PET/CT 3D Visualization of Head and Neck Squamous Cell Carcinoma extended to Mandible

To study an original 3D visualization of head and neck squamous cell carcinoma extending to the mandible by using [18F]-NaF PET/CT and [18F]-FDG PET/CT imaging along with a new innovative FDG and NaF image analysis using dedicated software. The main interest of the 3D evaluation is to have a better visualization of bone extension in such cancers and that could also avoid unsatisfying surgical treatment later on.

http://ift.tt/2CFoztv

World Health Organization and Its Initiative for Ear and Hearing Care

The World Health Organization (WHO) addresses ear diseases and hearing loss through its program on prevention of deafness and hearing loss. Recently, the World Health Assembly called for action at global and national levels to tackle the rising prevalence and adverse impact of unaddressed hearing loss. Following a public health approach toward this issue, WHO is focusing on i) raising awareness among policymakers and civil society; and ii) providing technical support to countries for promoting hearing care. Meeting this challenge requires a coordinated global effort with all stakeholders working together to make ear and hearing care accessible to all.

http://ift.tt/2GGvdly

Cochlear dead regions: Using the Threshold Equalising Noise (TEN) test to improve the assessment of potential cochlear implant candidates – The Oxford experience

Abstract

The Threshold Equalising Noise (TEN) test can be used to detect cochlear dead regions

Patients with cochlear dead regions may gain limited benefit from conventional amplification

The TEN test can be used to assess selected cochlear implant candidates who do not meet pure tone audiometry criteria for implantation

Our patients with cochlear dead regions had good outcomes following cochlear implantation

This article is protected by copyright. All rights reserved.

http://ift.tt/2CjaeqY

The effects of non-continuous positive airway pressure (non-CPAP) therapies on the aerodynamic characteristics of the upper airway of obstructive sleep apnea patients: a systematic review

Publication date: Available online 24 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hui Chen, Ghizlane Aarab, Jan de Lange, Paul van der Stelt, Frank Lobbezoo
PurposeThe effects of non-continuous positive airway pressure (non-CPAP) therapies on the airflow in the upper airway in obstructive sleep apnea (OSA) patients are not completely clear yet. Therefore, the primary aim of this systematic review was to determine the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway in OSA patients.MethodsA PICO (population/patient, intervention, comparison, outcome) search strategy, focusing on the effects of various non-CPAP therapies on the aerodynamic characteristics of the upper airway (viz., velocity, wall shear stress, wall static pressure, airway resistance, pressure drop, and pressure effort) of OSA patients, was conducted in the following databases: Medline (Pubmed), Excerpta medica database (EMBASE), and Web of Science. In this systematic review, inclusion criteria were: (1) adults diagnosed with OSA by polysomnography (PSG) recordings; (2) treatment outcome assessed by a second PSG recording; and (3) computational fluid dynamic (CFD) was applied.ResultsOf 51 retrieved unique studies, nine studies fulfilled the criteria for this systematic review. Seven studies were on maxillomandibular advancement (MMA) surgery, and two studies were on mandibular advancement device (MAD) therapy. The aerodynamic characteristics of the upper airway improved in OSA patients who underwent MMA surgery. However, the studies on MMA surgery included only responders to MMA surgery. In the responders to MAD therapy, the velocity, wall static pressure, and airway resistance of the upper airway decreased. In non-responders to MAD therapy, the wall static pressure and airway resistance of the upper airway increased.ConclusionThis systematic review suggests that MMA surgery and MAD therapy may improve several aerodynamic characteristics of the upper airway in OSA patients by CFD analysis. However, due to limitations of the selected studies, there is not enough evidence yet to support CFD analysis as a routine tool to predict treatment outcome in OSA patients.



http://ift.tt/2Fsp5xU

Providing Anesthesia in the Oral and Maxillofacial Surgery Office: A Look Back, Where We Are Now and a Look Ahead

Publication date: Available online 24 February 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Stuart Lieblich




http://ift.tt/2ESPmo3

Rapid bupropion-induced hepatotoxicity: a case report and review of the literature

Bupropion is an antidepressant that is also used as a non-nicotine method to aid in smoking cessation. Bupropion-induced hepatotoxicity is quoted to affect between 0.1% and 1% of treated patients with either a...

http://ift.tt/2Ch6bLE

Certain BCG-reactive responses are associated with bladder cancer prognosis

Abstract

A subset of bladder patients does not respond to BCG treatment effectively and the underlying reason behind this observation is currently unclear. CD4⁺ T cells are composed of various subsets that each expresses a distinctive set of cytokines and can potently shift the immune response toward various directions. In this study, we examined the CD4⁺ T-cell cytokine response in bladder cancer patients toward BCG stimulation. We found that bladder cancer patients presented a variety of responses toward BCG, with no uniform characteristics. Those patients with high IFN-γ and IL-21 expression in CD4⁺ T cells presented significantly better prognosis than patients with low cytokine secretion in CD4⁺ T cells. Tumor-infiltrating CD4⁺ T cells were significantly less potent in expressing IFN-γ, IL-4, and IL-17, and more potent in expressing IL-10 than circulating CD4⁺ T cells. In addition, we found no difference in CD80, CD86, or MHC II expression by macrophages from patients with different IFN-γ and IL-21 levels. However, the secretion of IL-12, a Th1-skewing cytokine, was released at significantly higher level by macrophages from patients with high IFN-γ or high IL-21 secretion. We also identified that modulating monocytes/macrophages by GM-CSF-mediated polarization resulted in significantly elevated expression of IFN-γ and IL-21 from CD4⁺ T cells. Overall, these results suggested that the specific types of responses mounted by CD4⁺ T cells were critical to the final outcome of bladder cancer patients and can be influenced by monocyte/macrophage polarization.

http://ift.tt/2HHhufA

Concurrent IgE-mediated NMBA-allergy in systemic mastocytosis

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Pascale Dewachter, Claudie Mouton-Faivre




http://ift.tt/2GGij7a

Relying on allergy skin test results

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jody Tversky, Maria Shtessel




http://ift.tt/2HKoys2

Cow's milk-associated chronic food protein-induced enterocolitis syndrome (FPIES) exacerbated by extensively hydrolyzed formula

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Shyam R. Joshi, J. Andrew Bird




http://ift.tt/2GCKALV

A case of neuropathic pain in monoclonal mast cell activation syndrome

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jeannie L. Bay, Kaye E. Sedarsky, Maureen M. Petersen




http://ift.tt/2HJuul5

Relationship between traffic related air pollution particle exposure and asthma exacerbations: association or causation?

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Yoomie Lee, Nathan Rabinovitch




http://ift.tt/2HI4t5n

Evaporative coolers are not associated with dust mite or mold sensitization in large pediatric cohort

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Neema Izadi, Kanwaljit K. Brar, Bruce J. Lanser




http://ift.tt/2GITh7x

Xolair®-induced recurrent anaphylaxis through sensitization to the excipient polysorbate

Publication date: Available online 23 February 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Emilie Perino, Nathalie Freymond, Gilles Devouassoux, Jean-François Nicolas, Frédéric Bérard




http://ift.tt/2HK1vO6

Herpes simplex virus (HSV) encephalitis in a young man: an unusual course

We present a case of cerebral venous sinus thrombosis (CVST) as a rare complication of herpes simplex virus (HSV) encephalitis. A young man with no pertinent medical history was diagnosed with HSV encephalitis. After initial treatment, he showed improvement in symptomatology until day 6 when he acutely developed new neurological deficits. An urgent MRI brain showed changes in left temporal lobe consistent with HSV encephalitis and lack of flow void in superior sagittal sinus. Subsequent magnetic resonance venography confirmed the diagnosis of superior sagittal sinus thrombosis along with thrombosis of bilateral frontoparietal cortical draining veins. Anticoagulation was immediately initiated and oral anticoagulation was continued for 1 year. He made complete recovery subsequently. Our case serves as a reminder for the treating clinicians to consider CVST in patients with HSV encephalitis who develop an unexpected new neurological deficits during early phase of appropriate treatment.

http://ift.tt/2FrCAhm

Pleuroparenchymal fibroelastosis with positive MPO-ANCA diagnosed with a CT-guided percutaneous needle biopsy

A 67-year-old woman was referred to our hospital because of gradually increasing dyspnoea on exertion for 6 months. Chest CT scan showed subpleural parenchymal fibrotic opacities with traction bronchiectasis in the bilateral upper lung fields. Serum rheumatoid factor and myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) were positive. There was no evident reason to suspect connective tissue disease such as ANCA-associated vasculitis or rheumatoid arthritis. We performed a CT-guided percutaneous needle biopsy of the subpleural lesion that showed slight uptake on the fluorodeoxyglucose-positron emission tomography (FDG-PET) CT scan. This specimen showed subpleural fibrosis as evidenced by an abnormal increase of elastic tissue and minimal collagen deposition, which indicated pleuroparenchymal fibroelastosis (PPFE). Although PPFE can be associated with a variety of causes, its association with MPO-ANCA is unknown. A CT-guided transthoracic lung biopsy caused no adverse events and was useful in the diagnosis of PPFE in our patient.

http://ift.tt/2EOWvWp

Blueberry eye: acquired total anterior staphyloma

Description

A 51-year-old woman presented to the ophthalmology emergency room with inability to close the eyelid, severe pain and light sensitivity in the left eye. Ocular examination showed severe conjunctival injection, deep corneal vascularisation, and extremely thin and protruded cornea, measuring 12x14 mm, with iridocorneal adhesions (figure 1A). The protruded lesion had a typical blueberry-like external appearance, due to the iris plugging the perforated ulcer. The patient's best corrected visual acuity (BCVA) was reduced to hand motion in the left eye and was 20/40 in the right eye, with the intraocular pressure within the normal range in both eyes. The patient was previously diagnosed with fungal keratitis following trauma but was non-compliant with topical antifungal agents and did not maintain a proper follow-up. A sclerokeratoplasty using a 14 mm corneal graft, as well as iridectomy and lensectomy, was performed in her left eye. The corneal graft remained clear...

http://ift.tt/2Ftpctb

Comparison of patient (POEM), observer (EASI, SASSAD, TIS) and corneometry measures of emollient effectiveness in children with eczema: findings from the COMET feasibility Trial

Abstract

Background

Eczema affects ~20% of children but multiple different outcome measures have hampered research into the effectiveness of different treatments.

Objectives

To compare the change in scores and correlations within and between five measures of eczema severity: Patient Orientated Eczema Measure (POEM), Eczema Area Severity Index (EASI), Six Area Six Sign Atopic Dermatitis (SASSAD), Three Item Severity (TIS), and skin hydration (corneometry).

Methods

Data from a feasibility trial that randomised young children with eczema to one of four emollients were used. Participants were followed for three months (84 days). Descriptive statistics (by emollient over time) and Spearman's correlation coefficients comparing scores at each time-point and absolute change (between adjacent time-points) for each outcome measure were calculated.

Results

197 children, mean age (SD) of 21.7 (12.8) months, were randomised. POEM and TIS appeared to capture a range of eczema severity at baseline but only POEM had close approximation to normal distribution. Mean POEM, EASI, SASSAD and TIS scores improved month-by-month, with POEM showing the greatest sensitivity (effect size 0.42). Correlations within POEM, EASI, SASSAD and TIS were moderate-to-good, decreasing over time. Correlations between measures were strongest for EASI, SASSAD and TIS. By contrast, corneometry scores were more variable, correlated less well over time, and were poorly correlated with the other measures.

Conclusions

Except for corneometry, all measures appear to change in relation to emollient use over time and correlate well with themselves. POEM demonstrated the greatest range of scores at baseline and change in eczema severity over the first 28 days.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ERsPrN

Cost-effectiveness of omalizumab for the treatment of Chronic Spontaneous Urticaria

Summary

Background

Chronic spontaneous urticaria (CSU) is a skin disease, with itchy hives and / or angioedema that last for at least 6 weeks without an obvious external trigger.

Objectives

The objective of this study was to determine the cost-effectiveness of omalizumab relative to standard of care (SoC; up to 4 times the daily dose of H1-antihistaminics) for the Netherlands from a societal perspective.

Methods

The Markov model used consisted of five health states based on Urticaria Activity Score over seven days (UAS7). Model settings and characteristics of the Dutch patient population were based on an online survey among clinical experts and were validated during an expert committee meeting. Transition probabilities were derived from the GLACIAL trial. Healthcare consumption, quality of life (using EQ-5D) and productivity losses were derived from a burden of illness study (ASSURE-CSU) among 93 Dutch patients. Healthcare consumption and productivity losses were valued using the Dutch costing manual. Comparator treatment was SoC, consisting of (up dosed) antihistamines. A ten-year time horizon was used.

Results

The incremental cost-effectiveness ratio (ICER) of omalizumab versus SoC was €17,502 per quality adjusted life year (QALY) gained. Productivity costs played an important role in the value of the ICER; discarding productivity costs resulted in an ICER of €85,310 per QALY.

Conclusions

Omalizumab is cost-effective compared to SoC. The outcomes of this study were used to establish omalizumab as third-line treatment in the Dutch treatment guidelines for CSU.

This article is protected by copyright. All rights reserved.

http://ift.tt/2FtUpwi

A randomized split-scalp study comparing Calcipotriol assisted MAL-PDT with Conventional MAL-PDT for the treatment of Actinic Keratosis

Summary

Background

Topical photodynamic therapy (PDT) is an approved treatment for actinic keratosis (AK). To enhance the efficacy of PDT for AKs, physical (ablative lasers and microneedling) and chemical (pro-differentiating drugs) pretreatments have been suggested.

Objectives

To compare the efficacy and safety of the combination of topical calcipotriol (CAL) before methylaminolevulinate (MAL)-PDT for AKs of the scalp versus conventional MAL-PDT in a randomized controlled-clinical trial.

Materials and Methods

Twenty patients with multiple AKs on the scalp were randomized to receive conventional MAL - PDT with previous curettage on one side of the scalp and CAL – assisted MAL-PDT applied once a day for fifteen days before the illumination with red light-emitting diode (37J/cm²) on the other side. After three months, patients were evaluated for the clearance of AKs, side effects and histopathology before and after the procedure. Protoporphyrin IX (PpIX) fluorescence was measured before and after illumination on both sides.

Results

All twenty patients completed the study. Overall AK clearance was 92.07% and 82.04% for CAL-PDT and conventional PDT respectively (p< 0.001). The AKs grade I showed similar response rate of 92.83% and 87.29% (p=0.055) respectively for CAL and MAL-PDT sides. However, AKs grade II showed more improvement on the CAL-PDT side (89.55%) compared with MAL-PDT (62.90%) (p<0.001). Before illumination, PpIX fluorescence intensity was higher on the CAL-assisted side (p=0.048). The treatment was more painful on the CAL-PDT side, although well tolerated. The mean VAS score was 5.40±1.43 on the CAL-PDT side and 3.95±0.69 on the conventional MAL-PDT side (p=0.001). Side effects such as erythema (p=0.019), edema (p=0.002), crusts (p<0.001) were more pronounced on the CAL-assisted side. Histopathological analyses were obtained from five patients and both sides showed improved keratinocyte atypia following PDT, with a slight more improvement on CAL- assisted side.

Conclusion

CAL-assisted PDT proved to be safe and more effective than conventional MAL-PDT for the treatment of AKs on the scalp. CAL pretreatment increased PpIX accumulation within the skin and may have enhanced the efficacy in this first human trial. As this is the first CAL-assisted PDT study in human skin, further and larger trials are needed to corroborate our findings.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EOz6nT